COVID-19: Ethnicity to Be Recorded on Death Certificates

Nicky Broyd

October 22, 2020

Ethnicity being recorded on death certificates is among the recommendations in the Government's first quarterly report on ethnic minority inequalities with COVID-19.

The publication follows Public Health England's initial risk report in June.

Changes will be made to the shielded patients list to take account of ethnicity risks and the new report said 95% of frontline NHS staff from ethnic minorities had already had an occupational risk assessment and agreed on any necessary actions.

The report said: "In summary, the evidence shows an increased risk for Black and South Asian ethnic groups. However, the relative risk of COVID-19 mortality is reduced when taking into account socioeconomic and geographical factors associated with different ethnic groups. Where people live, particularly in London and other cities, has had a large effect on the risk of individuals catching COVID-19.

"The current evidence clearly shows that a range of socioeconomic and geographical factors such as occupational exposure, population density, household composition and pre-existing health conditions may contribute to the higher infection and mortality rates for ethnic minority groups. Deprivation is a good marker of many of these factors."

'Disproportionate Impact' 

In a news release, Sir Mark Caulfield, professor of clinical pharmacology, Queen Mary University of London and chief scientist for Genomics England, said: "This important report into health inequalities and COVID-19 draws together important strands of evidence to highlight the disproportionate impact on ethnic minorities by identifying the key factors that contribute to their increased risk of infection and adverse outcomes. These include household size, deprivation, co-morbidities and particularly occupation, which highlights the vital contribution our diverse communities have made as key workers on the front line during the pandemic."

The BMA said the report was "long overdue".

Council Chair Dr Chaand Nagpaul commented: "While the report makes recommendations for the future and describes work in several areas that the BMA had long been calling for – such as some community initiatives and improving the way deaths are recorded – the key question remains: are BAME [Black and Minority Ethnic] people any better protected today from the impact of this virus?"

He continued: "Today, as we sit amid a second wave of infections, we know that about a third of those admitted to intensive care are not White - showing no change since the first peak. Meanwhile, Black and Asian people have been found twice as likely to be infected compared with White people.

“There needs to be more tangible action right now to protect BAME people. This could include providing resources to support individuals and businesses to ensure they have [the] right protective equipment and to ensure their workplaces are COVID secure. With higher numbers of BAME people in low-paid employment or living in deprived areas, it is vital to offer adequate funding that encourages individuals to be tested and to self-isolate if infected, given evidence that many feel that financial loss acts as a deterrent to do so."

Other experts have commented via the Science Media Centre.

Trish Greenhalgh, professor of primary health care services, University of Oxford, said: "It is encouraging that a Government report is considering what might be called the structural causes of inequalities as well as the (possibility of) biological ones. In other words, a person from a Black or South Asian background may be more likely to develop COVID-19, and more likely to become seriously ill and die from it, not just for biological reasons (eg, more likely to have comorbidities such as diabetes) but also – and perhaps primarily – for reasons linked to poverty and social injustice."

Future Research

Dr Hajira Dambha-Miller, GP and National Institute of Health Research (NIHR) clinical lecturer in general practice, University of Southampton, told the Science Media Centre: "I don’t think the report goes far enough in exploring the wider social factors that may contribute to viral transmission and death. Hopefully, studies like the one that we are leading will offer additional insights over the next few months."

In a statement given to the House of Commons, Equalities Minister Kemi Badenoch said: "The package of measures I've announced today are the first steps in my year-long review." She said they will give a better insight "into how the virus is impacting ethnic minority groups, how we can best protect those who may be most at risk and how we can address long standing public health inequalities".

An update is expected at the end of the next quarter.

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